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5
ORAL ENVIRONMENTTEETH
Enamel – hard, white outer covering surrounding the crown of the tooth. Consists of inorganic substances, calcium and phosphate.
Cementum – thin, bone-like material covering the root. Also consists of inorganic substances.
Dentin – a yellow bone-line material under the enamel Provides support Forms bulk of tooth Composed of collagen (20%) and calcium phosphate (75%)
Pulp – soft tissue in the center of the crown and root Contains nerves, blood vessels and lymph vessels Produces dentin Provides nourishment for tooth Functions as a sensory signal of injury
Pellicle – thin salivary film covering the tooth composed of proteins and lipids
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Figure 2: The Palatal Surface of the Upper Jaw
A diagrammatic representation of palatal surface of the upper jaw, with a full complement of permanent teeth
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Table 1: Approximate Age of Tooth Eruption
AGE AT ERUPTION
6 months7 1/2 months
7 months9 months
12-14 months16-18 months20-24 months
6-7 years6-8 years7-9 years9-12 years
10-12 years10-12 years11-13 years17-21 years Third molars
TOOTH
Cuspids First bicuspids Second bicuspids Second molars
Permanent teeth First molars Central incisors Lateral incisors
Upper lateral incisors First molars Cuspids Second Molars
Deciduous teeth Lower central incisors Upper central incisors Lower lateral incisors
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ORAL ENVIRONMENTGINGIVA / MUCOSA
Gingiva – dense fibrous tissue surrounding necks of teeth Covered by a smooth mucous membrane which bleeds easily when
penetrated Also called “periodontal tissue” or “gums”
Oral mucosa – “mucous membrane” lining the mouth
Peridontium - attachment apparatus consisting of Gingiva Cementum Periodontal ligament Jawbone Oral mucosa
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ORAL ENVIRONMENTSALIVA
A complex fluid secreted by salivary glands containing water, mucin, proteins, salts and enzymes.
Functions: aids in digestion lubricates both hard and soft tissues buffers cariogenic acids forms the pellicle provides minerals for repairing enamel / cementum
(remineralization) delivers antimicrobial agents (immunoglobulins, enzymes, etc.)
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ORAL ENVIRONMENTPLAQUE
Soft sticky, invisible film constantly forming in your mouth. Covers teeth and gums.
Oral mucosa cells Saliva Bacteria
Can be removed by brushing and flossing.
Gram + cocci Gram + rods Gram – anaerobes(healthy mouth) (gingivitis)
Formation / progression influenced by: Diet Host immune system Oral environment
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Inhibition of Plaque Accumulation
Measures Proposed
Increase in Total Numbers
Increase in Specific Bacterial
PopulationsInterbacterial
Adhesion
1. Keep tooth clean, free of pellicle, e.g., by toothbrushing
1. Use broad-spectrum anti-bacterial agents
Introduce specific measures, e.g.,
vaccines
Apply Ca2+ antagonists; destroy matrix, e.g., with proteolytic enzymes
2. Interfere with bacterial attachment mechanisms, e.g.,
with Ca2+ antagonists2. Remove mechanically with toothbrush, floss, etc.
3. Attack dextran and other adhesive bacterial secretions, e.g., with dextranases
4. Alter surface of tooth by physical-chemical means
Increase in Microbial Population
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ORAL ENVIRONMENTTARTAR
Calcification (crystallization of minerals) on the surface of the tooth formed mainly in the presence of plaque.
Rough surface promotes further growth of plaque Stains easily (yellow / brown) Most prevalent near salivary glands and around necks and roots of teeth Removed only by dentist
Tartar Control Agents (Pyrophosphate) Acts as crystal “poisons” to stop formation Easily degraded by oral enzymes / stabilized by fluoride and Gantrez.
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ORAL ENVIRONMENTCARIES
A progressively destructive, infectious disease resulting in: Demineralization of enamel / cementum Bacterial penetration to pulp Formation of macroscopic activity
Caries promotion Caries reductiondietary carbohydrate increased salivary flowreduced salivary flow reduced plaquecariogenic bacteria fluoride
Sound enamelplaque acid prod
mineral loss
salivaacid neutralization
mineral gain(fluoride)
Lesions
Cavity
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COMPOSITION & CHEMISTRY OF DENTIFRICES
DENTIFRICE:A dentifrice is a substance used with a toothbrush for the purpose of cleaning the accessible surfaces of the teeth (American Dental Association)
TOOTHPASTE:
Toothpaste is a colloidal suspension of a mixture of ingredients that must be carefully balanced in order to provide an efficacious, safe, and consumer friendly product
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ABRASIVE
Function: Cleaning and polishing
Characteristics: Solid, insoluble particles Abrasive Potential for fluoride interaction
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ABRASIVE
Types :
Silica Phosphate Salts – ie “Dical” Carbonates – ie Calcium Carbonate or Chalk Others
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Radioactive Dentin Abrasion Method
This procedure involves the use of accelerated toothbrushing apparatus and dentin section that contain radioactive phosphorous. The ADA standard was set at 100, which corresponds to RDA value of 475.
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Figure 7: In-vitro Abrasion Studies, RDA
This photograph shows a two-brush model abrasion machine, which is used in in vitro dentifrice abrasion studies.
Source: Stallard, Richard E. A Textbook of Preventive Dentistry (Second Edition).
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Comparative Abrasiveness of some Commercially Available Dentifrices as Determined by a Radioactive Dentin Procedure
Source: Stallard, Richard E. A Textbook of Preventive Dentistry (Second Edition).
DENTIFRICE MANUFACTURER PRINCIPAL ABRASIVE
ABRASIVITY INDEX
Sensodyne Block Drug Co. Silica 157Vote Bristol-Myers Co. Silica 134Plus White Plus Bishop Industries, Inc. Dicalcium Phosphate (anhydrous) 132Plus White Bishop Industries, Inc. Dicalcium Phosphate (anhydrous) 110Gleem II Procter and Gamble Co. Calcium Pyrophosphate 106Macleans (old formulation) Beecham Products, Inc. Calcium Carbonate 93Crest (Mint and Regular) Procter and Gamble Co. Calcium Pyrophosphate 88Close-Up Lever Brothers Co. Silica 87
Pearl Drops Carter-Wallace, Inc.Alumina and Dicalcium Phosphate (dihydrate) 72
Macleans (new formulation) Beecham Products, Inc. Dicalcium Phosphate (dihydrate) 68Ultra Brite Colgate-Palmolive Co. Dicalcium Phosphate (dihydrate) 64Colgate with MFP Colgate-Palmolive Co. Insoluble Sodium Metaphosphate 51Pepsodent Lever Brothers Co. Dicalcium Phosphate (dihydrate) 26
Thermodent Chas. Pfizer and Co.Magnesium Carbonate (basic) and Calcium Carbonate 24
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BINDER
Function:Used to stabilize toothpaste formulations to prevent separation of the liquid and solid phases
Characteristics:Can be natural or synthetic
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BINDER
Types:
Natural Polymers Carboxymethyl Cellulose (CMC) Carrageenans Xanthan Gum
Synthetic Polymers Others
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HUMECTANT
Function: Used in toothpaste to prevent loss of water and
subsequent hardening of the product upon exposure to air
Characteristics: Affect taste perception Proper usage level produce a clear translucent toothpaste
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SWEETENER
Function: An important part of toothpaste flavoring system
Characteristics: Government regulations
Non-cariogenic
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FLAVOR
Function: Improve taste of toothpaste
Characteristics:
One of the most important factors for consumer
A mixture of flavoring agents
35
Oral products have a unique and specialized flavor requirements. To be successful in oral products, a flavor must:
Have a pleasant taste while brushing Leave a pleasant taste in your mouth after
brushing Be compatible with the base
36
All factors being roughly equal – “mouthfeel” appearance, perceived therapeutic attributes, etc. – the consumer will look to flavor as the determinant in selecting a product for use day after day and year after year.
37
SURFACTANT
Function: Produce foam and aid in the removal of debris
Emulsifies flavoring agents
Characteristics:
May react with other toothpaste components
High level may cause mucosal irritation
38
SURFACTANT
Types:
Sodium Lauryl Sulfate Sodium N-Lauroyl Sarcosinate Sodium Dodecyl Benzene Sulfonate PEG Oil
39
FLUORIDE ACTIVES
Function: Increase resistance to enamel solubility
Characteristics:
Regulated by Government
Restricted usage level
Soluble fluoride ion is essential for activity
40
FLUORIDE ACTIVES
Types:
Sodium Fluoride NaF
Sodium Monofluorophosphate MFP
Stannous Fluoride SnF2
41
Anticaries Dentifrices: FDA Tentative Final Monograph
Package size limitation
Identity (labeling)
Indications
WarningsDirections
Aids in the prevention of dental caries or cavities or decay (as deemed appropriate by the manufacturer); misleading statements not permitted
"Adults and children 2 years of age and older; brush teeth thoroughly at least once daily or as directed by a dentist. Children under 6 years of age should be supervised in the use of this product." Also for stannous fluoride dentifrices, "This product may produce surface staining of the teeth. Adequate toothbrushing may prevent these stains which are not harmful or permanent and may be removed by your dentist."
None required for dentifrices
Anticaries active agents (category I)
Package shall not contain more than 260 mg total fluorine per package
Contains established name of drug; identifies product as "anticavity", "fluoride", "dentifrice", or "toothpaste", as appropriate
Sodium fluoride, 0.22%Sodium monofluorophosphate, 0.76%Stannous fluoride, 0.4%
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OTHER ACTIVES
Tartar PolyphosphatesZinc Citrate
Plaque / Gingivitis TriclosanSnF2Chlorhexidine
Zinc Citrate
Desensitizer Potassium Nitrate
Whitening Calcium PeroxideHydrogen Peroxide
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TYPICAL COMPOSITION
Ingredients Weight %
Humectants 60 – 20
Water 0 – 50
Binders 0 – 12
Abrasive 18 – 50
Flavor 0.5 – 2.0
Sweetener 0.2 – 1.0
Surfactant 0.5 – 2.0
Fluoride 0.2 – 1.2
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U.S. FORMULA COMPARISONIngredients Colgate P&G Unilever SKB
Humectants Glycerin Glycerin Glycerin GlycerinSorbitol Sorbitol Sorbitol SorbitolPEG PEG PEG PEG
Binders CMC Xanthan CMC CMCCarrageenan Carbopol CarrageenanXanthan
Abrasive Silica Silica Silica PCCDical SilicaPCC
Flavor Mint Mint Mint MintSweetener Saccharin Saccharin Saccharin SaccharinSurfactant SLS SLS SLS SLSFluoride NaF NaF NaF MFP
MFP SnF2 MFPSnF2
45
TOOTHPASTE CONSIDERATIONS
Safety Efficacy Consumer Friendly
Pleasing taste Ease of use Pleasing appearance
46
PRODUCT CRITERIA
Minimum one year shelf life Easily dispensable Compatible with the package Efficacious Safe
48
Ingredients of Dentifrices and Oral Rinses
Dentrifrice Oral RinseTherapeutic agent(s) Therapeutic agent(s)
Abrasive -Surfactant(s) Surfactant(s)Humectant(s) Humectant(s)Flavor Flavor
- Ethanol
Thickener(s) -Coloring ColoringWater Water
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Mouthwash ComponentsIngredient Function
Alcohol
Adds bite and freshness. Enhances flavor impact. Helps solubilize some flavor components. Contributes to cleansing action and antibacterial activity.
Flavor
Makes mouthwash pleasant to use. Adds a refreshing, cool quality to oral cavity immediately and for some time after use. Makes breath temporarily pleasant by imposing a pleasant note over breath aroma. Some flavors exert significant antibacterial effect.
HumectantAdds "body" to product, inhibits crystallization around closure.
Surfactant
Used for solubilization of flavor. Provides foaming action. Assists removal of oral debris by lowering surface tension. Can be antibacterial. (Selection is critical in antibacterial mouthwashes; must be compatible with antibacterial active.)
Water Major vehicle to carry other ingredients.
Special ingredients: Antibacterial agent To enhance antibacterial efficacy.
Astringent salts Can interact with proteins of saliva and oral mucosa. Chlorophyllins For topical deodorization. Fluoride Anticaries agent.